Conciliación de los medicamentos en los servicios de urgencias / Medication reconciliation in emergency departments

Los errores de medicación (EM) son comunes en el ámbito hospitalario y conducen aun incremento de la morbilidad y mortalidad y de los costes económicos. Estos errores ocurren sobre todo durante la transición de pacientes entre los diferentes niveles asistenciales. La posibilidad de que se produzcan estos errores se ve aumentada en los servicios de urgencias (SU) por la naturaleza de éstos. Desde instituciones sanitarias a nivel mundial, se reconoce la conciliación de la medicación (CM) como la solución a esta problemática. Se define como el proceso que consiste en obtener un listado completo y exacto de la medicación previa del paciente y compararlo con la prescripción médica después de la transición asistencial. Si se encuentran discrepancias deben considerarse y, si es necesario, modificar la prescripción médica para finalmente comunicar al siguiente responsable en salud del paciente y al propio paciente, la nueva lista conciliada. Este documento de consenso ofrece una serie de recomendaciones generales para la conciliación de los medicamentos. Incluye para cada subgrupo una serie de recomendaciones específicas de tipo farmacológico, que permiten un abordaje personalizado del tratamiento del paciente que acude a urgencias en base a las características clínicas individuales. Existirán casos en los que se desestime las recomendaciones aquí descritas, ya que la relación riesgo/beneficio requerirá una valoración individualizada. Esta valoración individualizada para el paciente se llevará a cabo por el equipo multidisciplinar responsable de su asistencia sanitaria (AU)

Medication errors, which are common in hospitals, lead to higher morbidity, mortality, and expenditure. Errors are most common when patients are transferred from one level of care to another, and the likelihood of mistakes is higher in emergency departments because of the intrinsic nature of emergency care. The internationally recognized remedy for this situation is medication reconciliation, defined as the process of obtaining a complete, accurate list of the patient's prior medications and comparing it to the list of medicines prescribed after admission to a new level of care. Discrepancies should be considered and prescriptions changed if necessary. Both the person who will be responsible for the next phase of care and the patient should be informed of the new list of medications. This consensus statement offers a set of general recommendations for medication reconciliation. Specific recommendations for each subgroup of medications are also included to allow emergency department prescribing to be tailored to individual patient characteristics. The recommendations in this statement should be overridden in some cases if the risk-benefit ratio suggests that further individualization is required. Individualized assessment of medications should be carried out by a multidisciplinary team responsible for the patient’s care (AU)

[Detecting adverse drug events during the hospital stay]. / Detección de acontecimientos adversos producidos por medicamentos durante la estancia hospitalaria.

INTRODUCTION: The principal objective was to determine the incidence rate of adverse drug events (ADEs) in hospitalised patients and evaluate the event prevention percentage. METHODS: Multi-centre, prospective observational study lasting four months, performed in five hospitals providing different levels of care. We included all adult patients who were admitted to one of the selected centres for longer than 48 hours and who required pharmacological treatment. ADEs were identified by direct observation and the use of previously defined alarm signals. The Karch-Lasagna scale was used to determine the causality relationship, and the Schumock and Thornton questionnaire adapted by Otero was used to evaluate ADE preventability. Preventable drug-induced adverse events were classified according to the taxonomy that the Ruiz-Jarabo 2000 group defined, and coordinated by ISMP-Spain. RESULTS: We included 1,550 patients, 159 of whom experienced at least one ADE (10.3 %). The preventability percentage was 51.6 %, which represented 5.3 % of the total sample. The endocrine system (34.8 %) and the cardiovascular system (20.7 %) were the most affected by preventable ADEs. Antibiotics were responsible for 16.5 % of all ADEs. 9.3 % of all preventable ADEs were triggered by use of opiates. The vast majority of preventable ADEs (36.3 %) resulted from omitting a necessary medication. Only 4.4 % of preventable ADEs are considered to be serious. CONCLUSIONS: There is a high incidence rate of ADEs during patients' hospital stay (10.3 %), and half of them (51.6 %) could have been prevented. Implementation of an automatic alarm system and certain best practices for problem spots along the care circuit will help detect and avoid preventable ADEs.

Detección de acontecimientos adversos producidos por medicamentos durante la estancia hospitalaria / Detecting adverse drug events during the hospital stay

Introducción: El objetivo principal ha sido determinar la incidencia de acontecimientos adversos producidos por medicamentos (AAM) en pacientes hospitalizados y evaluar su porcentaje de prevención. Métodos: Estudio multicéntrico, prospectivo y observacional de 4 meses de duración, realizado en cinco hospitales de distinto nivel asistencial. Se incluyó a todos los pacientes adultos que ingresaron por más de 48 h en alguna de las unidades seleccionadas y requirieron tratamiento farmacológico. La identificación de los AAM se realizó mediante la observación directa y la utilización de unas señales de alerta, previamente definidas. Se utilizó el algoritmo de Karch-Lasagna, para determinar la relación de causalidad, y el cuestionario de Schumock y Thornton adaptado por Otero et al para evaluar la evitabilidad del AAM. Los AAM prevenibles se clasificaron siguiendo la taxonomía definida por el Grupo Ruiz-Jarabo 2000, coordinado por el ISMP-España. Resultados: Se incluyó a 1.550 pacientes, de los que 159 presentaron, al menos, un AAM (10,3 %). La tasa de evitabilidad fue del 51,6 %, lo que representa un 5,3 % de la muestra total. El sistema endocrino (34,8 %) y el cardiovascular (20,7 %) fueron los más afectados por los AAM prevenibles. Los antibióticos representaron el 16,5 % de todos los AAM. En cuanto a los AAM prevenibles, el 9,3 % de ellos se desencadenaron por la utilización de opiáceos. La gran mayoría de los AAM evitables fue consecuencia de la omisión de un medicamento necesario (36,3 %). Sólo un 4,4 % de los AAM evitables se consideró graves. Conclusiones: La incidencia de pacientes con AAM durante la estancia hospitalaria es alta (10,3 %), y la mitad de ellos (51,6 %) se podría haber prevenido. La implantación de un sistema automático de alertas y ciertas prácticas de mejoras en los puntos conflictivos del circuito sanitario ayudarían a la detección y la prevención de los AAM evitable (AU)

Introduction: The principal objective was to determine the incidence rate of adverse drug events (ADEs) in hospitalised patients and evaluate the event prevention percentage. Methods: Multi-centre, prospective observational study lasting four months, performed in five hospitals providing different levels of care. We included all adult patients who were admitted to one of the selected centres for longer than 48 hours and who required pharmacological treatment. ADEs were identifi ed by direct observation and the use of previously defi ned alarm signals. The Karch-Lasagna scale was used to determine the causality relationship, and the Schumock and Thornton questionnaire adapted by Otero was used to evaluate ADE preventability. Preventable drug-induced adverse events were classifi ed according to the taxonomy that the Ruiz-Jarabo 2000 group defi ned, and coordinated by ISMP-Spain. Results: We included 1,550 patients, 159 of whom experienced at least one ADE (10.3 %). The preventability percentage was 51.6 %, which represented 5.3 % of the total sample. The endocrine system (34.8 %) and the cardiovascular system (20.7 %) were the most affected by preventable ADEs. Antibiotics were responsible for 16.5 % of all ADEs. 9.3 % of all preventable ADEs were triggered by use of opiates. The vast majority of preventable ADEs (36.3 %) resulted from omitting a necessary medication. Only 4.4 % of preventable ADEs are considered to be serious. Conclusions: There is a high incidence rate of ADEs during patients’ hospital stay (10.3 %), and half of them (51.6 %) could have been prevented. Implementation of an automatic alarm system and certain best practices for problem spots along the care circuit will help detect and avoid preventable ADEs (AU)

[The hemodynamic profile of the response to amrinone treatment in severe heart failure]. / Perfil hemodinámico de la respuesta al tratamiento con amrinona en la insuficiencia cardíaca severa.

The hemodynamic response to amrinone was analyzed in 19 patients with severe heart failure (NYHA III or IV). In 17 patients, 2 bolus of amrinone (0.75 mg/kg) were administered with an interval of 30 minutes, while a single bolus only was administered in 2 patients. In all patients the initial bolus was followed by continuous perfusion of Amrinone (10 micrograms/kg/min in 17 patients; 7 and 5 micrograms/kg/min in the remaining two). Cardiac index increased from 1.8 +/- 0.2 to 2.5 +/- 0.4 l/min/m2 (p less than 0.01), and pulmonary capillary wedge pressure and mean right atrial pressure decreased significantly (from 24 +/- 5.2 to 14 +/- 6 mmHg, p less than 0.01; and from 8.7 +/- 6.5 to 3.2 +/- 3.4, p less than 0.05 respectively). There were no significant changes in mean blood pressure (93 +/- 17 versus 88 +/- 13), heart rate (81 +/- 15 versus 84 +/- 14 beats per minute) and systolic work index (26.4 +/- 10.7 versus 37.7 +/- 12.3 g-m/m2). The maximum effect was obtained at 60 minutes and maintained throughout the period of monitoring (8 hours). In the 2 patients who received a single bolus of amrinone the maximum effect was reached at 30 minutes (cardiac index 1.3 +/- 0.1 versus 2.5 +/- 0.1 l/min/m2; pulmonary capillary pressure 24 +/- 5 versus 16.8 +/- 6.5 mmHg; mean right atrial pressure 11 +/- 1 versus 3.5 +/- 3.5 mmHg), and was followed by a progressive loss of efficiency, until effect had totally disappeared and situation basal returned, between the third and fourth hours.(ABSTRACT TRUNCATED AT 250 WORDS)